Provider Demographics
NPI:1528396678
Name:D'AMICO, CARA MARIE (C-PNP, ARNP)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:MARIE
Last Name:D'AMICO
Suffix:
Gender:F
Credentials:C-PNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 1798
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32050-1798
Mailing Address - Country:US
Mailing Address - Phone:904-652-0870
Mailing Address - Fax:904-652-2308
Practice Address - Street 1:10250 NORMANDY BLVD
Practice Address - Street 2:STE 201
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-8059
Practice Address - Country:US
Practice Address - Phone:904-652-0870
Practice Address - Fax:904-652-2308
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9271693363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006243100Medicaid